Quantifying Aerosolization of Facial Plastic Surgery Procedures in the COVID-19 Era: Safety and Particle Generation in Craniomaxillofacial Trauma and Rhinoplasty

Gadkaree SK, Derakhshan A, Workman AD, Feng AL, Quesnel AM, Shaye DA.

What this paper says

Measuring airborne particles during simulated procedures on cadavers, standard nasal bone cuts and rasping produced no detectable particles, while piezoelectric saw use produced significant particles at the surgeon's mouth level.

Overview

COVID-19 raised concern about airborne spread during surgery on the nose, where viral load is high. This study measured airborne particle generation in real time during simulated rhinoplasty and facial trauma procedures on cadavers, both beside the surgical site and at the surgeon's face.

Sections of note

Airborne particulate in the 1 to 10 micrometer range was quantified with an optical particle sizer during cadaveric simulated rhinoplasty and facial trauma.
Procedures tested: mandibular plate screw drilling, calvarial drilling, nasal bone osteotomy, nasal dorsal rasping, and piezoelectric saw use.
Particles were measured adjacent to the surgical site and at surgeon mouth level.
Mandibular plate screw drilling without irrigation generated significant particulate at both locations, p below 0.01; irrigation reduced it at mouth level to non-significant levels.
Calvarial drilling produced substantial particulate above baseline adjacent to the site, p below 0.01.
Standard nasal osteotomies and dorsal rasping generated no detectable airborne particulate.
Piezoelectric saw use generated significant particulate adjacent to the site, p below 0.001, and at mouth level, p below 0.01; smaller particles made up a higher proportion at mouth level.

What it means for a patient

The conventional bone work in rhinoplasty, cutting with a chisel and filing the bridge, produced no measurable airborne particles.
The piezoelectric saw, which cuts bone with ultrasonic vibration, did produce them.
Irrigating during drilling reduced particles reaching the surgeon.
Limits: cadaver simulation, particles measured rather than virus, and no infection outcomes.

Why this paper matters

Guidance during the pandemic restricted procedures assumed to generate aerosols, often without measurement. This shows most rhinoplasty bone work does not, while identifying one instrument that does. It measures particles, not infectious transmission.

Terms

Aerosolization: The generation of airborne particles small enough to stay suspended.
Optical particle sizer: An instrument counting and sizing airborne particles in real time.
Osteotomy: A controlled surgical cut through bone.
Rasping: Filing down bone or cartilage.
Piezoelectric saw: An instrument that cuts bone using ultrasonic vibration.
Calvarial: Relating to the vault of the skull.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“COVID-19 poses a potentially significant infectious risk during procedures of the head and neck due to high viral loads in the nasal cavity and nasopharynx. Facial plastic surgery has significant exposure to these areas during craniomaxillofacial trauma procedures and rhinoplasty. Methods: Airborne particulate…”

Excerpt; the full abstract is on PubMed.